• People Talk and My Ear Bleeds


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    Tuesday, September 16, 2014

    Abuse, the NFL, and Due Process

    Recently, you can't go anywhere, read or watch anything, and not hear about the National Football League and its abuse scandal. Ray Rice knocking out his then-fiancé. Greg Hardy beating up a woman. Adrian Peterson accused of child abuse by disciplining with a switch.

    Somehow, this has turned into a societal referendum on discipline - spanking, specifically - and safety nets for abused partners.

    This has made the American people into experts on abuse lately. The cynic in me says "This is wonderful," because, in my four years of taking care of abused children that came to the hospital, we were ALWAYS woefully understaffed with people that could properly tell abuse from non-abuse, and do a good forensic exam, or forensic interview.

    The civic organizations we worked with for psychiatric care for patients and parents, the police and state who prosecuted perpetrators, were always horribly underfunded.

    I see roughly one patient per week in the ICU with serious injury (or death) from physical abuse. But now, we have almost an entire nation who can accurately perform a forensic interview and examination via the internet. No more CPS write-ups, forensic exams, brain death exams, worrying about serum sodiums or intracranial pressures, getting ophthalmology to come in late at night, etc., etc.

    The reality is, we have no increase in experts, on another example of America's penchant for self-righteous indignation without education. I am all for the discussion, when people take the time to educate on the situation, American Academy of Pediatrics recommendations, etc.

    But most people don't.

    And as a doctor who sees this at least once a week, we must do our job to prove that what we see came from actions alleged. If we jump to conclusions, we do the child a disservice. I've seen more than one child come in with bruises consistent with abuse only to find underlying bleeding issues no readily apparent on a routine CBC.

    So if people in positions to report or make decisions are going to highlight this, let them truly become educated too. It's better for the child and future children.

    Secondly, I have serious concerns about our society over the last 1-2 weeks. "Innocent until proven guilty," must apply in ALL scenarios in this country, or we end up in the same situation the NFL is currently in - creating arbitrary punishments for crimes not properly vetted.

    How many people have been exonerated from death row sentences by DNA evidence? Or new evidence? Or findings of police misconduct?

    As much as we may feel certain that Ray Rice knocked out his wife, or Adrian Peterson abused his child, we must let the system play like it's supposed to.

    Holding second grand juries is scary - because it's almost double jeopardy that our constitution forbids. If you are a strict constitutionalist, you should definitely oppose Adrian Peterson being tried again. Can we suspend or fire everyone in America when a crime is alleged? There are many spurious allegations out there, or ones done in good faith that still end up being wrong.

    No, as much as it might hurt us to be patient, in a case like this we MUST be patient and not crucify the alleged perpetrator until the system runs its course so that the system is infallible, and justice without caveat can be served for the child and safeguarded for the next child. Otherwise, we're all just a modern mob with torches storming to Frankenstein's castle.

    Finally, as an organization, the NFL has made a huge mistake with Ray Rice. In his case, the system has played out, he was convicted and given a sentence for a first time offender. Then, the NFL made it's suspension. Yes, it was woefully too lenient (IMHO), but when the video came out, you can't, as an organization, go back and produce arbitrary punishment again. That's where Goodell has major problems. he's just made his justice system COMPLETELY arbitrary. No, the NFL must stick with the punishment it doled, take egg on the face for doing it wrong, and set something correct up for the future.

    My concern is not the child defended - yes! let's do that. CPS can take Peterson's child out of the home. We have a court system. Heck, it's here in Houston that it's happening. BUT, if America "educates" itself without true knowledge, then we are worse off than before. I'm glad people are talking, but the media needs to talk correctly. And due process must be observed or the next child isn't protected.

    Friday, September 05, 2014

    Apprenticeship in America

    Recently, Cathay Pacific instituted a program titled "I Can Fly," which hopes to give juniors and seniors in high school 8 weeks of direct experience to aviation. Not flying, but aviation - learning about everything from passenger sales to airports, cargo to catering. This is a Canadian program, partnering Toronto with Cathay Pacific.

    America lost it's apprenticeship culture years ago. Sure, we all read of our Founding Fathers learning watchmaking, or silver smithing, or printing at the hands of someone else. But by the end of World War II, America's government-subsidized public high school network was robust enough to provide basic education. People graduated, applied, and got jobs. Then they received on-the-job training.

    As the economy developed and higher education became more important, that model persisted. Now, some companies are going back to Europe to study their apprenticeship systems. The hope is that large companies, like Siemens in Germany, can help counterparts in the USA close a gap where 4 million jobs sit unfilled although 10 million people are unemployed.

    The problem is, this hasn't extended to one sector of the economy gravely hit by this labor shortage - health care. Physician training, specifically, is woefully inefficient - a byproduct of this stage-by-stage top-down, myopic, it's-always-been-done-this-way approach. Since the Flexner report in 1910 (see pdf), American medical education time has been seen as an empty cardboard box to be filled with whatever is possible until the timer dings. As medical knowledge advances, we try to shove more and more into the box faster and faster, without stepping back and reimagining the box itself, or the method of pouring.

    "Then I wised up and got out while I still could."

    It is time for a serious look at the ACGME, AAMC, and LCME - the accreditation bodies of American medical education. They are bloated dinosaurs that do not move fast enough to deal with the times. With expected shortages of up to 52K physicians by 2025, it's past time to look at other ways of educating future medical professionals.

    We need to shorten medical education by at least 2 years. We need to decrease debt incurred by physicians in training. We need to change the culture to make medicine more family friendly. We need to increase responsibility given trainees to help them progress to self-sufficiency faster.

    Perhaps we could learn something from Cathay Pacific. We should at least look.

    Tuesday, September 02, 2014

    2014 TBE Play For A Cause Winner: Baton Rouge Children's Advocacy Center!!

    I'm incredibly sorry for the long delayed post. Congratulations to all who played in the TBE March Madness pool this year. It was a great tournament that hinged on an Elite Eight game. If Arizona had beaten Wisconsin, many possibilities would have remained alive. However, Wisconsin won, and that sealed the deal for Dr. Z and the BRCAC. Congrats!!

    Below is the press release.

    ***Dated: May 9, 2014***

    Congratulations to Dr. Zeretzke and the Baton Rouge Children’s Adovocacy Center!

    The Bleeding Ear’s Play For a Cause March Madness charity pool (“TBE Play For a Cause”) was started in 2008 as a way to funnel a good time into good deeds. Two years earlier, while volunteering at an orphanage in Vietnam, I saw how much $100 – a relatively small amount in America – could do for needy children.

    That first year we raised $100 for Heifer International. Every year we’ve had an increase in players, money, fun, and watched some excellent tournaments. This year we have raised $260 for the Baton Rouge Children’s Advocacy Center. Congratulations to all involved.

    The Baton Rouge Children’s Advocacy Center (BRCAC) is a non-profit organization whose mission is to “lessen the trauma experienced by child victims when abuse allegations are investigated, and to provide support during any subsequent proceedings within the criminal justice system.”

    The BRCAC:

    •Protects children who have been sexually and/ or physically abused and helps prevent further abuse.
    •Provides therapeutic counseling during the time of disclosure and thereafter.
    •Maintains and reconstitutes a healthy family by healing the scars of abuse
    •Enhances community safety by preventing the perpetration of sexual/physical abuse.
    •Coordinates the prosecution of the criminal cases

    In 2013, BRCAC served 312 children who were sexually abused, physically abused, or had witnessed a severe crime.

    We cannot be more proud to help support the Baton Rouge Children’s Advocacy Center.

    The Bleeding Ear
    Largest donation in the history of TBE Play For A Cause